Flag of the World Health Organization. Image: United States Mission Geneva, licensed under CC BY 2.0.
Cross-border movement can turn a local outbreak into a diplomatic problem before governments fully assess the risk. International pandemic governance brings together rules, institutions and practices designed to reduce that dangerous delay. It does not replace national health systems. Instead, it creates a common circuit in which notification to the World Health Organization (WHO) connects national detection, coordinated response and negotiated access to medical products within the same emergency.
The current architecture has three main pillars. WHO, the United Nations specialized agency created in 1948, supplies the technical authority and political forum. The International Health Regulations, usually called the IHR, make it a legal duty for 196 States Parties to maintain surveillance and notify WHO about international risks. The Pandemic Agreement was adopted by the World Health Assembly on May 20, 2025, but on June 26, 2026 it was still not operational and not open for signature. The unfinished annex on pathogen access and benefit-sharing, the PABS system, was the missing step.
Summary
- WHO can coordinate alerts and recommend measures, but states remain responsible for domestic law, hospitals, borders and implementation.
- The 2005 IHR turn surveillance, notification and response into legal duties; the 2024 amendments add the pandemic emergency category and strengthen equity language.
- The Pandemic Agreement, adopted in 2025, moves governance toward prevention, financing, production capacity and access to vaccines, diagnostics and therapeutics.
- On June 26, 2026, the agreement still depended on the PABS annex, which links pathogen and sequence sharing to access to medical products.
Where International Health Cooperation Came From
International health cooperation predates WHO. In the nineteenth century, epidemics such as cholera and yellow fever put pressure on ports and quarantine rules. The first International Sanitary Conference, held in Paris in 1851, tried to standardize quarantine measures so that governments would not block ships in unpredictable ways. From the beginning, the health problem was an economic coordination problem as well. One national decision could protect a port while paralyzing commerce for others.
In the early twentieth century, this cooperation acquired permanent bodies. The International Sanitary Bureau in Washington and the Office international d’hygiène publique in Paris reflected the same logic: epidemics required shared information, and national barriers worked only when governments understood the threat they were trying to contain together. The League of Nations created a Health Organization in 1924, focused on technical assistance, pharmaceutical standardization and epidemic control. After the Second World War, WHO replaced that fragmented architecture with a universal agency whose constitutional mandate is to seek the highest attainable standard of health for all peoples.
This origin explains a tension that remains. International public health emerged to contain cross-border risks, yet its instruments depend on sovereign states that control the concrete sites of action, from hospitals to industrial policy. WHO therefore does not operate as a world health government. It works as a technical authority, normative forum and coordination center in a system where domestic implementation remains with governments.
What WHO Can Do
WHO’s most visible power in an emergency is the power to signal. It can convene governments, activate technical networks and recommend public health measures. When the director-general declares a Public Health Emergency of International Concern, the decision does not create domestic law. It turns a health event into a political and operational alert for governments and sectors that need to adjust routes, care and supplies quickly.
That authority depends on procedure. The director-general weighs the affected state’s report, scientific evidence, the risk of international spread and the advice of an Emergency Committee. If an emergency is declared, WHO issues temporary recommendations. They guide surveillance, risk communication and proportionate public health measures. They are not legally binding and expire after three months, which is why the Emergency Committee has to be reconvened periodically.
The limit is as important as the competence. WHO cannot police directly, rewrite national laws or command hospitals. The Pandemic Agreement adopted in 2025 repeated this boundary explicitly, since the negotiations took place amid strong political suspicion in some countries. The legal point is straightforward: states accepted international coordination without transferring to WHO the authority to govern their internal policies.
How the IHR Turn Surveillance Into a Diplomatic Obligation
The IHR of 2005 are the central legal instrument for international health alerts. They require States Parties to maintain core capacities to prevent, detect, assess, notify and respond to risks. These capacities are concrete. A country can comply with the IHR only when epidemiological surveillance, laboratory support, reliable information and entry-point teams can move quickly. Without those administrative and technical capacities, the duty to notify WHO comes too late.
The practical mechanism runs through National IHR Focal Points. When a national authority detects an event that may constitute a Public Health Emergency of International Concern, it must assess the event using the decision instrument in annex 2 of the IHR and notify WHO. The regulations allow WHO to request verification of information obtained from informal or unofficial sources. In that way, the system tries to prevent the silence of one government from delaying international assessment of a risk.
The IHR protect against excessive responses. Their purpose is to control the international spread of disease in a way that is proportionate to the public health risk, while avoiding unnecessary interference with international traffic and trade. A country should therefore not use an emergency as an automatic justification to block movement when less restrictive measures are sufficient. In practice, proportionality depends on trust, rapid information and technical capacity, precisely the elements that are often scarce at the beginning of a crisis.
PHEIC, Emergency Committee and Pandemic Emergency
PHEIC is a legal decision inside the IHR, not merely an epidemiological description. The acronym refers to a Public Health Emergency of International Concern. It applies to extraordinary events that create a risk of international spread and may require a coordinated response. Covid-19 was declared a PHEIC in January 2020 and characterized as a pandemic in March 2020.
The 2024 IHR amendments introduced a higher category: the “pandemic emergency”. It remains a type of PHEIC. To receive that classification, a communicable disease must spread across several states or create a comparable risk. The crisis must strain health systems, threaten substantial social and economic disruption and require rapid, equitable and enhanced international action. The new category separates serious alerts from events capable of disrupting several sectors at the same time.
Even at that level, the main legal consequence remains the issuance of non-binding temporary recommendations. The change lies in the political and operational signal. By naming an emergency as pandemic, WHO makes it harder for governments to treat the event as isolated, regional or manageable through ordinary measures. The alert pressures states to activate national plans and prepare procurement, hospitals and public messaging before the crisis escapes control.
What Covid-19 Exposed
Covid-19 showed that formal rules do not work without capacity and trust. Many governments were slow to recognize the risk and translate it into testing, tracing and public communication. Others adopted travel and export restrictions with little coordination. In vaccine access, inequality became visible when wealthy countries bought doses in advance and many low- and middle-income countries depended on multilateral mechanisms that did not receive doses at the promised speed.
WHO created or supported important instruments. The ACT Accelerator sought to accelerate health technologies and strengthen national systems. The COVAX Facility, its vaccine pillar, tried to buy and distribute doses more equitably. C-TAP proposed sharing knowledge and intellectual property. The Solidarity trials organized international clinical research. World Health Assembly resolution 73.1, adopted in May 2020, called for an independent evaluation of the global response, and the Independent Panel for Pandemic Preparedness and Response presented recommendations in 2021.
These initiatives revealed limits. COVAX delivered billions of doses, yet it did not eliminate delays for poorer countries. C-TAP had limited reach. Companies and governments resisted sharing sensitive technology. Debates at the World Trade Organization over intellectual-property flexibilities showed that vaccine production depends on a material chain: regulatory authorization, inputs, factories and logistics have to work together. For that reason, equity concerned the concrete capacity to turn scientific knowledge into available products during an emergency.
The 2024 IHR Amendments
The amendments approved on June 1, 2024 sought to correct some of these failures without creating a supranational health authority. They entered into force on September 19, 2025 for most States Parties. Four States Parties that had rejected the procedural amendments of 2022 follow their own timetable until September 19, 2026. The amended text reinforces surveillance, preparedness and response, but its effect depends on domestic implementation.
The central changes combine alert language with institutional capacity. The definition of a pandemic emergency improves how the regime names events of the highest gravity. The commitment to solidarity and equity appears especially in access to medical products and financing. A States Parties Committee should facilitate implementation and review, while National IHR Authorities are meant to improve domestic coordination and communication among countries.
These changes move the IHR closer to an agenda of capacity. To notify WHO quickly, a government must turn laboratories, data, personnel and legal authority into public trust. To apply proportionate measures, it must protect the health system and economic life without trampling individual rights. The amended IHR try to turn the lesson of Covid-19 into clearer preparedness obligations, without by themselves solving shortages of financing or administrative capacity.
The Pandemic Agreement
The Pandemic Agreement came from the assessment that the IHR alone were not enough. The new instrument shifts part of the discussion toward prevention, financing and material access to medical products. In December 2021, the World Health Assembly created an Intergovernmental Negotiating Body to draft an instrument on pandemic prevention, preparedness and response. After three years of negotiations, the Assembly adopted the text on May 20, 2025, but adoption did not make the agreement immediately effective.
The agreement covers subjects that the IHR address only in part. The One Health approach links human, animal, plant and environmental health. Many pandemic risks begin in the relationship among people, animals and ecosystems. Rather than treating these themes as a technical checklist, the text organizes them as a chain: health systems depend on protected workers, research depends on regional production and technology, and international logistics must move products to the place where the emergency occurs. A future Conference of the Parties would oversee implementation, following a common model in multilateral treaties.
On June 26, 2026, however, the agreement was still not in force. The unresolved point was the PABS annex, on pathogen access and benefit-sharing. That system is meant to regulate a delicate exchange. Countries would share pathogens and genetic sequence information quickly. In return, resulting medical products would be shared according to public health need. Without the PABS annex, the Pandemic Agreement is not opened for signature, ratification or entry into force. After missing the target of the May 2026 World Health Assembly, negotiators were expected to resume the discussion in July 2026.
Financing, Compliance and Equity
The main problem of pandemic governance is financing capacities before the crisis begins. Epidemiological surveillance, laboratories and regional production require permanent spending, as do training and pharmaceutical regulation. Political attention, by contrast, often arrives only after an emergency has started. For that reason, the Pandemic Agreement provides for a Coordinating Financial Mechanism, and the G20 agenda created a Pandemic Fund at the World Bank in 2022. These mechanisms try to reduce the gap between legal commitments and real capacity.
Compliance is fragile. WHO can monitor and recommend, as well as coordinate responses and expose problems, but it does not have sanctions comparable to those of a court or a trade organization. If a country is slow to report an outbreak or underfunds surveillance, the response usually runs through public pressure and technical assistance, with loss of trust. This fragility frustrates those who want stronger rules. At the same time, it preserves decision space for states that fear external interference in sensitive choices about health, the economy and borders.
The equity dispute runs through the entire regime. Developing countries argue that sharing samples and data without guaranteed access to medical products repeats the asymmetry seen during Covid-19: the biological risk is global, yet industrial benefits remain concentrated where there are laboratories, factories and purchasing power. Countries with large pharmaceutical industries, and companies in the sector, fear that overly rigid obligations could reduce research incentives or create controls that are hard to execute. PABS concentrates this tension because it links scientific surveillance and biological sovereignty to intellectual property, public procurement and distributive justice.
The Real Reach of the Regime
International pandemic governance works best when it is understood as political infrastructure. WHO helps organize information and reduce coordination delays. The IHR turn surveillance and notification into legal obligations. The Pandemic Agreement tries to complete that structure with rules on financing, supplies and benefit-sharing. None of these instruments eliminates national politics, economic inequality or competition among major powers.
That limit does not make the regime irrelevant. It shows where cooperation has to operate. A pandemic is fought in national health, border, budget and production structures that depend on alerts, technical standards and supply chains no government controls alone. Health diplomacy does not replace the state. It tries to make sovereignty compatible with a risk that does not respect borders.